Disability Rights 23: Cruel, inhuman or degrading treatment

In addition to the human rights laws in the Constitution of Uganda there are several other rights granted to persons with disabilities (PWDs). These rights are given by law in the Persons With Disabilities Act 2006 (PWDA) which is modeled on the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Whether you are a PWD or not, these laws apply to you.

Section 34 of the PWDA says that PWDs should not be subjected to cruel, inhuman or degrading treatment. Also, no one is allowed to subject a PWD to a medical or scientific experiment without their free and informed consent.

PWDs are more likely to be the victims of violence than non-disabled people. And women with disabilities are much more likely to be the victims of violence than their non-disabled counterparts (see Document on Violence against Women with Disabilities). Violence against women includes the following:

• forced isolation, confinement, and being hidden in the family home 
• forced and coerced administration of psychotropic drugs or putting drugs in the food 
• forced and coerced institutionalization 
• restraint and isolation in institutions 
• creating pretextual situations to make the woman appear violent or incompetent in order to justify institutionalization and deprivation of legal capacity 
• labelling anger and self-assertion by women as behavior that is “mentally ill and dangerous” (especially if the woman has been previously institutionalized) 
• withholding medication that the person uses voluntarily, medical and mobility aids, or communication equipments 
• denial of necessities and purposeful neglect 
• threats to neglect children or pets 
• verbal abuse and ridicule 
• physical abuse or threat of it 
• being left in physical discomfort or embarrassing situations for long periods of time 
• threats of abandonment 
• violations of privacy 
• being ignored 
• financial abuse 
• restraint, strip searches, and solitary confinement that replicate the trauma of rape 
• rape by staff and other inmates/residents of institutions 
• forced abortion 
• forced sterilization

For people with mental health problems the situation is equally bleak. In a 2013 report Psychiatric hospitals in Uganda: A human rights investigation, inspectors from the Mental Disability Advocacy Center (MDAC) and Mental Health Uganda (MHU) noted in their report that Uganda has a mental health service that is under developed and under resourced. Mental health laws are outmoded and unenforceable and date back to the colonial era. There is no reference to the human rights for people in hospital with mental health problems and furthermore, there is no protection against maltreatment or abuse. These are some human rights abuses uncovered by the inspection team:

• People with mental health issues were frequently locked in dark and cold seclusion rooms, often naked, lying on the same floor where they were forced to urinate and without access to a toilet. 
• People with mental health issues were not free to leave hospital without the permission of staff, whether or not they were legally detained... The majority were forcibly brought to psychiatric hospitals in shackles or ropes, and in very few cases was there any lawful authority for such practices. 
• Compulsory and forced treatment was the norm, and the right to informed consent and refusal of treatment was completely denied. 
• The entire system was based on a highly pharmacological approach. Alternatives such as psychological or psycho-social interventions were virtually unknown and individualised care was completely absent. 
• The conditions in many hospitals were appalling, including at Butabika hospital male and female acute wards, which were seriously overcrowded. 
• The physical health care needs of the majority of inpatients were neglected. 
• Women with mental health issues were subjected to additional abuses. Women reported not being provided with sanitary pads and had to wear dirty underwear and were left without access to clean clothes or washing facilities. 
• Food was not provided by the government in hospitals, except at Butabika. This was particularly concerning as many people with mental health issues had been abandoned by their communities and families and were left destitute. 

If you are a woman with a disability and you have been the victim of abuse; or if you have a mental health problem and you have been a victim of abuse; or if you are member of the public and you have witnessed any abuse; you can report the incident to the National Council for Disability for further investigation. 

Psychiatric hospitals in Uganda: A human rights investigation.
The absence or lack of enforceable legislation is of serious concern, meaning that mental health care and abusive practices can take place without any regulation whatsoever. Uganda must now stop stalling on the passage of new, robust legislation based on and extending human rights protection to those people who use psychiatric services in the country. It should do this through the passage of legislation as soon as possible, and must ensure that people with mental health issues and their representative organisations are involved in the process.

This law is written like this in section 34 of the Persons With Disabilities Act 2006:

34. Cruel, inhuman or degrading treatment.

(1) A person or institution shall not subject a person with disability to cruel, inhuman or degrading treatment.

(2) A person or institution shall not subject a person with disability to medical or scientific experimentation without the free and informed consent of the person concerned.